• Korean Journal of Adult Nursing
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• v.18 no.1
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• pp.125-135
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• 2006

Purpose: The purpose of this study was to identify pain intensity according to activities over postoperative days and to identify factors of patient satisfaction with pain management after abdominal surgery. Methods: The subjects were 123 patients who were admitted at a general surgical ward and had abdominal surgery from Mar. 2005 to June 2005. The collected data were analyzed using the SPSS 12.0 program. Results: The average postoperative pain scores were 6.13 at POD 1, 5.46 at POD 2, and 4.22 at POD 3. In stepwise multiple regression analysis a total of 40% of variance in satisfaction with pain management was accounted for by pain intensity on POD 3 at rest (29.4%) and attitude toward using pain medicine (6.6%), and side effects of pain medicine (4.0%). Conclusion: According to the findings of this study, patients had inadequate pain management after abdominal surgery. Therefore, nurses need to provide educational programs focused on changing attitudes toward using pain medicine, to reduce side effects of pain medicine, and to develop nursing intervention for relieving pain.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.117-120
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• 1997

Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transdermal fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical/diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patient's analgesic demand was drastically reduced and described her pain as "1 to 3" of "10". Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during fecal 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.317-320
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• 1998

Since Reiestad and Str$\ddot{o}$mskag reported interpleural installation of local anesthetic solutions as a technique for the management of postoperative pain in the patients undergoing cholecystectomy, renal surgery and breast surgery, many physician applied this technique for upper abdominal pain from various reasons such as technically simple, effective pain relief, less respiratory depression. So we tried interpleural analgesia in two patients who suffered from severe upper abdominal pain. One had upper abdominal pain due to chronic pancreatitis and the other had right upper abdominal pain after PTBD (percutaneous transhepatic bile drainage) for biliary cirrhosis and systemic jaundice. Both were injected 10 ml of 1% lidocaine and infused continuously with 1% lidocaine (2 ml/hr) using 2-Day Baxter$^{(R)}$ infusor. After bolus injection of lidocaine, pain scores (VAS 0~100) were recorded below 25mm and had not exceed that level during continuous infusion. After removing the catheters, two patients were all satisfied with this therapy. Our experiences with this technique showed that continuous infusion of local anesthetics through an interpleural catheter is effective in the control of refractory upper abdominal pain without any complication.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.145-159
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• 2024

Dental injections are routinely performed and can result in pain and anxiety in patients. This systematic review aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) in dental injections for pain management in patients undergoing dental treatment. Indexed databases, including PubMed, EMBASE, Scopus, ISI Web of Knowledge, and Cochrane Library, were electronically searched without a time limit up to February 2024. A risk of bias evaluation was performed using the Cochrane tool. A preliminary investigation using electronic and manual methods yielded 4,920,881 manuscripts. Based on the eligibility requirements, 13 randomized control trials (RCTs) were included. Self-assessed pain was determined using the visual analog scale, Face, Legs, Activity, Cry, Controllability scale, or Wong-Baker face pain scale. Eight RCTs demonstrated a notable decrease in needle pain in patients undergoing dental needle injections using PBMT. Based on current evidence, PBMT may help reduce needle pain related to dental anesthesia. Further standardized studies are needed to assess the significance of PBMT for postoperative pain in patients undergoing dental injections.

• The Korean Journal of Pain
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• v.24 no.3
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• pp.169-171
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• 2011

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.128-131
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• 1999

Stellate ganglion block is a well established method for the management of certain pain syndromes (e.g., chronic regional pain syndrome, facial pain) in the cervicothoracic region and upper extremity. The stellate ganglion resides between the C7 transverse process and the head of the first rib. Anesthetic injections for the stellate ganglion block are typically made at the level of the transverse process of either the C6 or C7 vertebrae to avoid the pleura, vessels, and nerve roots. Method of positioning the needle tip directly at the ganglion has been described, but are problematic because of the risk of injury to or injection into adjacent structures. It is necessary to know the exact anatomic position of the stellate ganglion when permanent blockade is required by means of radiofrequency thermocoagulation. Whereas fluroscopy shows only bony feature, computerized tomography also images nerves, vessels, and lung, allowing accruate needle placement. We report a case of the percutaneous radiofrequency thermocoagulation of the stellate ganglion after computerized tomography-guided localization.

• The Korean Journal of Pain
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• v.25 no.2
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• pp.126-129
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• 2012

Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.106-113
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• 2021

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

• The Korean Journal of Pain
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• v.29 no.3
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• pp.164-171
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• 2016

Background: Nefopam has been known as an inhibitor of the reuptake of monoamines, and the noradrenergic and/or serotonergic system has been focused on as a mechanism of its analgesic action. Here we investigated the role of the spinal dopaminergic neurotransmission in the antinociceptive effect of nefopam administered intravenously or intrathecally. Methods: The effects of intravenously and intrathecally administered nefopam were examined using the rat formalin test. Then we performed a microdialysis study to confirm the change of extracellular dopamine concentration in the spinal dorsal horn by nefopam. To determine whether the changes of dopamine level are associated with the nefopam analgesia, its mechanism was investigated pharmacologically via pretreatment with sulpiride, a dopaminergic D2 receptor antagonist. Results: When nefopam was administered intravenously the flinching responses in phase I of the formalin test were decreased, but not those in phase II of the formalin test were decreased. Intrathecally injected nefopam reduced the flinching responses in both phases of the formalin test in a dose dependent manner. Microdialysis study revealed a significant increase of the level of dopamine in the spinal cord by intrathecally administered nefopam (about 3.8 fold the baseline value) but not by that administered intravenously. The analgesic effects of intrathecally injected nefopam were not affected by pretreatment with sulpiride, and neither were those of the intravenous nefopam. Conclusions: Both the intravenously and intrathecally administered nefopam effectively relieved inflammatory pain in rats. Nefopam may act as an inhibitor of dopamine reuptake when delivered into the spinal cord. However, the analgesic mechanism of nefopam may not involve the dopaminergic transmission at the spinal level.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.43-50
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• 1995

The purpose of this study was to compare postoperative analgesic effect according to intravenous doses of ketorolac. The ninety-eight adult patients, scheduled for elective surgery under general anesthesia, were randomly assigned to receive saline or one of the five doses of ketorolac (10, 15, 30, 45, 60mg). After recoverg from anesthesia, saline or ketorolac was injected intravenously, and the visual analogue score, sedation secore, mean blood pressure, heart rate, and the incidence of nausea and vomiting were measured 30 minutes, 1 hour and 2 hours the injection. Saline or 10 mg of ketorolac had no postanalgesic effect. Above 15 mg of ketorolac had analgesic effect, but this analgesic effect was not increased with increasing doses of ketorolac (30, 45, 60 mg). Any side effects (nausea, vomiting, excessive sedation, cardiopulmonary depression, and renal and hematologic adverse events) was not observed associated with ketorolac administration. These results suggested that 15 mg of ketorolac is the most reliable dose for postoperative anlgesia in intravenous administration.